title: Effects of nasal application of an epinephrine and lidocaine mixture on the hemodynamics and nasal mucosa in oral and maxillofacial surgery.
abstract: OBJECTIVE
  Our purpose was to investigate the influences of nasal pretreatment with a mixed solution of epinephrine and lidocaine (E-L pretreatment) on the systemic hemodynamics and the mucosa of the inferior nasal concha, which is carried out for expansion of the nasal cavity and the prevention of mucosal injury before nasotracheal intubation.
  
  
  METHODS
  Subjects included 29 adult patients undergoing oral and maxillofacial surgery. This study consisted of 2 parts. In part 1 (n = 18), the effects of E-L pretreatment on the systemic hemodynamics were studied before (pre-Anesth group, n = 10) and after (post-Anesth group, n = 8) induction of anesthesia. Changes of the mucosal volume and the blood flow of the inferior nasal concha also were observed by optic bronchoscopy and noncontact type laser-Doppler flowmetry, respectively. In part 2 (n = 11), changes in the serum concentrations of epinephrine and lidocaine after the E-L pretreatment were determined by high performance liquid chromatography and enzyme immunoassay, respectively.
  
  
  RESULTS
  The heart rate increased at 2 and 3 min after E-L pretreatment in pre-Anesth group (P < .05), but not in post-Anesth group. The cross section of the nasal cavity decreased from 66% to 42% (n = 8, P < .05). The mucosal blood flow decreased from 60 to 22 AU (n = 8, P < .01). The serum epinephrine concentration increased from 24 to 185 pg/mL.
  
  
  CONCLUSIONS
  The E-L pretreatment provided characteristic evidence for useful expansion of the nasal cavity and for reduction of the nasal mucosal blood flow with less systemic hemodynamic effects, although further investigation is needed for the determination of the proper epinephrine concentration in E-L pretreatment.
authors.affiliation: Department of Anesthesiology, and the Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan. watanabe@med.kurume-u.ac.jp
authors.forename: Kimiko
authors.initials: K
authors.lastname: Kameyama
authors.forename: Seiji
authors.initials: S
authors.lastname: Watanabe
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kano
authors.forename: Jingo
authors.initials: J
authors.lastname: Kusukawa
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000379:methods; D000769:Anesthesia, Inhalation / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D004347:Drug Interactions; D004837:Epinephrine / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D008012:Lidocaine / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000187:drug effects*; D009297:Nasal Mucosa / Q000098:blood supply / Q000187:drug effects*; D019647:Oral Surgical Procedures / Q000379:methods*; D011184:Postoperative Period; D011229:Preanesthetic Medication; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine